The candiate's long-term career goal is to develop the requisite skills to become an independent nurse-researcher in cancer prevention and control with a primary focus on elderly, minority, and medically under-served populations. Related career development objectives include: 1) developing a research agenda that targets key issues for nurse-based cancer control targeted to high-risk women, such as non-adherence to cancer screening guidelines; availability of definitive care for those screened; and cost implications if innovative approaches to screening; 2) developing strong theoretical knowledge base is cancer prevention and control and related sciences, e.g., epidemiology, behavioral science, and health services research; and, 3) exploring ethical issues surrounding provision of cancer screening to vulnerable and at risk populations. This proposal is consistent with the candidates immediate and long-term career goals. This proposal will use an existing cohort of 2300 low-income African American women who participated in a mammogram screening programin the District of Columbia to describe barriers to regular ongoing mammography screening participation among elderly women, and to test an innovative nurse-based randomized clinical trail (RCT) designed to increase regular annual screening use. The specific aims of the research are to: 1) develop profiles of elderly, minority, poor women of the District of Columbia who do or do not adhere to annual breast cancer screening guidelines; 2) determine the relationship between structural, process, objective and subjective factors to screening guidelines adherence; 3) conduct an RCT that compares a nurse-based community outreach model with a nurse- based in-reach approach designed to enhance adherence by elderly; and, 4) determine cost effectiveness of each of the interventions. The primary hypothesis to be tested in this study is that women who receive an intensive nurse-based community intervention will adhere to breast cancer screening guidelines (i.e., return for annual mammography) more often than those who receive a nurse-based in-reach approach, or more often than controls who receive standard information about breast cancer screening. This research will fill important gaps in our knowledge on how to using nursing practice to improve the poor breast cancer outcomes experienced by elderly, minority, poor women.